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Cay (ke {long e}) it is a low island made mostly of coral or sand.
a quay, same pronounciation, is a wharf or a paved embankment for loading/unloading ships
the second acceptable pronounciation of both is ka (long a)

30 years ago I visited Great Harbor Cay in the Bahamas and Cay was pronounced with a long A...I still say it with the long A although I have heard Key. Another pronounciation issue...Antiga or Antigua. On the island and on Jimmy Buffet songs it is Anteega.

After reading about Half Moon Cay for several months I found that it is supposed to be pronounced Key! Well, I am a slow learner so I now call it Half Moon Cay-Key. Maybe by December I will get it right!

And I pronounce both R's in February and library and nuclear not nucular and realtor not realitor. But once I get something wrong it's difficult to un-learn it!

Apparently both are technically acceptable but on lovely Half Moon Cay it is most definitely pronounced "key".

I also pronounce "quay" as "key" though there are myriad different ways to pronounce that. The correct alternate pronounciation is, yes, "cay", like the way you would expect the island to be pronounced Lots of Americans say "kway" but that is not correct. I stick with the most common British version, "key" (how often do you have Americans using the word quay anyway?). In French it is spelled quai and pronounced roughly as "keh", like the first part of "KEttle".

As for whether "cay" and "quay" are the same, no, they're totally different. A cay is a small, low island. A quay is a place where one ties up a ship - it is a synonym for wharf; that is a dock which is parallel to the shoreline (whereas a pier is perpendicular to, or at least protrudes from the shore). Confusingly I have read that "quay" can also be spelled "key", just to muddy things further. At least there can't be any controversy over pronounciation when it's spelled that way .